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Metoclopramide

Classification

Antiemetic, dopamine antagonist

Indications

CCP: Nausea and vomiting

Contraindications

Hypersensitivity to metoclopramide
Bowel perforation
Seizure disorders
Extrapyramidal reactions
Monoamine oxidase inhibitor therapy within the past 14 days

Adult dosages

CCP: Nausea and vomiting

0.1 mg/kg IV/IO/IM to a single maximum dose of 10 mg
May repeat every 6 hours as required; total daily dose limit 0.5 mg/kg

Pediatric Considerations And Dosing

CliniCall consultation required prior to administration as limited data available.

Not authorized for infants < 1 year of age

Mechanism Of Action

Blocks dopamine receptors in the chemoreceptor trigger zone of the central nervous system. Enhances GI tract motility and accelerates gastric emptying.

Pharmacokinetics

Onset: 1-3 minutes (IV); 10-15 minutes (IM)
Peak: 15 minutes (IV)
Duration: 1-2 hours (IV,IM)

Adverse Effects

> 10%:

Gastrointestinal: Dysgeusia (nasal spray: 15%)
Nervous system: Drowsiness (~10-70%; dose related), dystonic reaction (≤ 25%; dose and age related)

1-10%:

Nervous system: Fatigue (~10%; dose related), lassitude (~10%; dose related), restlessness (~10%; dose related)

Frequency not always defined:

Cardiovascular: Atrioventricular block, bradycardia, cardiac failure, flushing (following high IV doses), hypertension, hypotension, supraventricular tachycardia
Dermatologic: Skin rash, urticaria
Endocrine & metabolic: Amenorrhea, endocrine disease (elevation of aldosterone), fluid retention, galactorrhea not associated with childbirth, gynecomastia, hyperprolactinemia, porphyria
Gastrointestinal: Change in bowel habits, diarrhea, nausea
Genitourinary: Urinary frequency, urinary incontinence
Hematologic & oncologic: Agranulocytosis, leukopenia, methemoglobinemia, neutropenia, sulfhemoglobinemia
Hypersensitivity: Angioedema, hypersensitivity reaction, tongue edema
Nervous system: Akathisia, confusion, depression, dizziness, drug-induced extrapyramidal reaction, hallucination, headache, insomnia, neuroleptic malignant syndrome, parkinsonism, seizure, suicidal ideation, tardive dyskinesia (total cumulative dose and duration of treatment related)
Neuromuscular & skeletal: Laryngospasm (rare)
Ophthalmic: Visual disturbance
Respiratory: Bronchospasm, laryngeal edema

Source: Metoclopramide. In: Lexicomp Online, UpToDate, Waltham, MA.

Warning And Precautions

May cause CNS depression.
May cause extrapyramidal symptoms, typically acute dystonic reactions. Higher doses increase these risks.
High doses and long term therapy (> 12 weeks) may cause tardive dyskinesia.
May prolong QT interval in some patients (particularly heart failure with renal impairment).